When is surgery necessary?
Tendons in the shoulder, hand and the foot (e.g., rotator cuff, mallet finger, plantar) are the most commonly injured. What happens to tendons when they are injured? Why do some injuries require surgery while others don’t?
Mild tendinitis* is inflammation of a tendon. The tendon, which connects muscle to the bone, sustains minor tears from acute/abrupt forces. As a result, movement may be painful, and/or the inflamed site may be tender or painful to touch.
As with most injuries, the body’s immune system triggers and uses inflammation to heal. Blood clotting, germ fighting, injury-site cleaning, and tissue regenerating growth factors all occur because of inflammation.
Mild tendinitis may be expected to heal through home care or with physical therapy in between several days and six weeks.
WHEN INFLAMMATORY RESPONSE DOESN’T WORK
However, the body’s inflammatory response does little to heal a tendon when it is in the tendinosis phase or when it is torn/ruptured, which is the end-stage of tendinopathy.
When there is a tendon rupture, many patients find themselves in need of surgery. Blood flow to tendons is scarce. Blood reaches this tissue more so via synovial fluid diffusion than by way of blood vessels. Moreover, in tendinosis, the tissue is so severely degraded that that it requires medical intervention to restore the ability of the associated limb (or finger in the case of the hand) to function.
CAUSE OF TENDINOSIS
While acute force is a cause of tendinitis, an even greater force is not a cause of tendinosis. Tendons are twice the strength of muscle; so, the muscle or ligament might tear first! Tendinosis, an advanced tendonopathy, results from years of repetitive activities such as keyboard use, luggage handling, or hammering.
If a person ignores the aches and pains, if they work through the discomfort with the aid of pills and creams, he/she is at risk of an advanced/chronic condition such as tendinosis. That’s why it pays to seek medical advice early on when there are symptoms that aren’t reduced by self-care.
Other risk factors for tendinosis are:
- Age over 60
- Use of fluoroquinolones (e.g., Ciprofloxacin)
- Prior tendinopathy
*May be spelled tendinitis or tendonitis